MALIGNANT OTITIS EXTERNA
&
OTOMYCOSIS
KARICKAL SAJI AJESH
M1871
MALIGNANT OTITIS EXTERNA
• Malignant external otitis (MEO) is an infection that affects the
external auditory canal and temporal bone. The causative organism
is usually Pseudomonas aeruginosa, and the disease commonly
manifests in elderly patients with diabetes. The infection begins as
an external otitis that progresses into an osteomyelitis of the
temporal bone. Spread of the disease outside the external auditory
canal occurs through the fissures of Santorini and the
osseocartilaginous junction.
SIGNS AND SYMPTOMS
• The pain is out of proportion to the physical examination findings.
Marked tenderness is present in the soft tissue between the
mandibular ramus and mastoid tip. Granulation tissue is present at
the floor of the osseocartilaginous junction. This finding is virtually
pathognomonic of malignant external otitis (MEO). Otoscopic
examination may also reveal exposed bone.
• Inflammatory changes are observed in the external auditory canal
and the periauricular soft tissue.
• Other signs and symptoms include the following:
• Diabetes (90%) or immunosuppression (illness or treatment related)
• Severe, unrelenting, deep-seated otalgia
• Temporal headaches
• Purulent otorrhea
• Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
EVALUATION
LABS
• Blood
• Erythrocyte sedimentation rate and C-reactive protein
• Blood glucose
• Culture and sensitivities from the external auditory
canal
IMAGING
• Computerized tomography
• Magnetic resonance imaging
• Gallium citrate Ga 67 scan
• Technetium Tc 99 methylene diphosphate bone
scanning
TREATMENT
• Antibiotic Therapy :
o The treatment depends on the administration of systemic anti-
microbial therapy with anti-pseudomonal activity, typically a
fluoroquinolone in cases caused by pseudomonas aeruginosa,
however, with the widespread use of ciprofloxacin in upper
respiratory tract infections.
o The duration of treatment depends on the response to therapy
o The treatment should be stopped one week after a normal gallium
citrate Ga 67 scan.
• Hyperbaric Oxygen Therapy
• Although it has been widely used in the treatment of MOE, many
studies showed no added benefit for using it as an adjuvant for
medical or/and surgical therapy.
• Surgical Therapy
• Surgical management is reserved for the patients in whom medical
therapy has failed to cure the disease. Surgical therapy includes
local debridement, removal of bony sequestrum, and abscess
drainage. However, there is no indication for facial nerve
decompression in patients with facial nerve involvement; finally, the
surgery did not show any prognostic benefits.
OTOMYCOSIS
• Otomycosis is a fungal infection that affects one, or occasionally
both, of the ears.
• It mostly affects people who live in warm or tropical areas. It also
often affects people who swim frequently, live with diabetes, or have
other chronic medical and skin conditions.
SYMPTOMS
The following symptoms are common for otomycosis:
• pain
• itching
• inflammation
• swelling
• redness
• flaky skin
• ringing in the ears
• feeling of fullness in the ears
• discharge of fluid from the ears
• hearing problems
CAUSES
• A fungus causes otomycosis. Common fungi include Aspergillus and Candida.
• Otomycosis is more common in tropical and warm regions because fungi can grow
better in these areas. This infection is also more common during the summer
months. Fungi need moisture and warmth to grow.
• People who swim in contaminated water are more likely to get otomycosis. Even
swimming or surfing in clean water can increase the risk.
TREATMENT
• Cleaning
• Ear drops
• Oral medications
• Topical medications
THANK YOU